Ethnic and Gender Diversity in Pathology: A Dream Deferred

Background Equity, diversity, and inclusion (EDI) remain an elusive dream in the physician workforce in the United States of America (USA). Many studies have documented the tangible and intangible benefits of EDI, including the caregiver, patients, and healthcare organizations. Objective We aim to examine the ethnic and gender diversity trends of the active residents in pathology in United States residency programs. Methods A retrospective cross-sectional study was conducted on the ethnicity and gender distribution of pathology residency trainees from the academic year 2007-2018. The data was compiled from the American Association of Medical Colleges (AAMC) annual report. Data was entered and analyzed using Microsoft Excel 2013 (Microsoft Corporation, Redmond, WA, USA). Frequencies and percentages were calculated, and bar charts and pie charts were used for graphical representation. Results Almost 35,000 US pathology residents were enrolled according to AAMC during this particular period. The highest trend of enrolling in the field of pathology was observed in 2010 and remained the same for years. This shows that the field of pathology in the USA had some acceptance all these years. The most popular speciality in which most residents were enrolled was anatomic/clinical pathology (80%) in which females were dominant over other fields. Conclusion Over the years, we have failed to overcome gender and ethnicity diversity. Gender and ethnicity have a significant influence on leadership positions, academic ranks, and research productivity among pathology faculty members in the USA.

Frequency of impaired glucose tolerance and its correlates in females of reproductive age in urban slums of Lahore, 2019

BACKGROUND

The prevalence of diabetes mellitus has almost reached global epidemic proportions. Fortunately, the progress of the disease can be stemmed at the prediabetic level. The objective of the present study was to determine the frequency of impaired glucose tolerance (IGT) and its predictors in females of reproductive age in the urban slums of Lahore.

MATERIALS AND METHODS

A cross-sectional study was conducted among females of reproductive age in the slums of metropolitan Lahore. The calculated sample size was 384. Data were collected using a structured questionnaire covering demographic variables, lifestyle, medical, and dietary history. The oral GT test was carried out on the study participants after a 10 hour overnight fasting. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS version 23). Frequency distributions and percentages were calculated for categorical variables, and the mean and standard deviation were calculated for continuous variables. The Chi-square test or Fisher's exact test, as appropriate, was used to determine the association between IGT and various categorical variables. Logistic regression analysis was performed to determine the correlates of IGT after adjusting for confounders.

RESULTS

The final sample size was 394 women; 17% of whom had IGT, and 8.6% had newly diagnosed diabetics. Results of logistic regression showed increased waist/hip ratio, lower literacy of father or husband, age, and low intake of pulses as significant predictors of IGT (P < 0.05).

CONCLUSION

The frequency of IGT is high in females of reproductive age living in the urban slums of Lahore. There is a need for targeted health promotion and educational activities to improve the health and social conditions of slum dwellers.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work.  The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Water and sanitation risk exposure in children under-five in Pakistan

BACKGROUND:

Children under-five constitute 11.9% (n = 20,447,628) of the total population of Pakistan. Poor water and sanitation in Pakistan cause 97,900 deaths annually, 54,000 of whom are children under-five.

MATERIALS AND METHODS:

This study calculates an index for water and sanitation risk for children under-5 in Pakistan to give a detailed understanding and insight into the prevalent risks. Data from Pakistan Integrated Household Survey 2011–12 are used. Stata 15.0 was used for data analysis. A risk index was created by integrating hazard and vulnerability factors including toilet facilities, water source, mother's education, and the number of children in the household. Children were ranked according to their risk score in three categories: low risk, medium risk, and high risk. For each level of risk, profiles of children are created at the national, regional (urban, rural), and provincial levels.

RESULTS:

Out of 20.5 million children under-five in Pakistan, 71.6% live in rural areas. About 24.9% of children benefit from pipe-borne drinking water; 15.5% of children have toilets connected to the public sewerage system; 62.6% of the children have mothers who had no education; and 50.5% of children live in households with three or more children. It appeared that 57.5% of children are at high risk of poor water and sanitation as compared to merely 1.3% of children at low risk. Around 69.9% of children living in rural areas are at high risk compared to 24.6% of children in urban areas. In Balochistan, 77.9% of children are at high risk, the highest of all provinces.

CONCLUSION:

The majority of children under-five in Pakistan are at high risk owing to poor water and sanitation. A comprehensive public health program is needed to address the key indicators related to child health risk identified in this research such as safe drinking water, improved sanitation, education and mothers' awareness, and population growth.

The striatal adenosinergic modulation of ethanol-induced motor incoordination in rats: possible role of chloride flux

Previous studies from our laboratory have provided strong evidence that brain adenosine modulates acute ethanol (i.p.)-induced motor incoordination (MI) through receptor mediated mechanism(s). Recently, we have reported the involvement of the striatum in ethanol-induced MI as well as the striatal adenosinergic modulation of the ethanol-induced motor deficit. The present study was thus designed to further characterize the modulatory effect of striatal adenosine on ethanol-induced MI and to look for its functional correlation with chloride flux within the rat striatum. Intrastriatal microinfusion of adenosine A1 receptor agonist N6-cyclohexyladenosine (CHA) and antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), significantly accentuated and attenuated, respectively, the motor incoordinating effect of ethanol while having no effect on the normal motor coordination in saline-treated control animals. These data confirmed the role of striatal adenosine in ethanol-induced MI. The selectivity of interactions between adenosine A1 agonist and antagonist and ethanol was further confirmed by the study in which neither intrastriatal CHA nor DPCPX significantly altered the MI induced by sodium pentobarbital. Previously, we have shown that intrastriatal Ro15-4513 not only significantly attenuated ethanol-induced MI but also blocked its accentuation by intrastriatal CHA. It is well known that Ro15-4513 antagonizes many, but not all, CNS effects of ethanol by blocking the ethanol potentiation of GABA-stimulated uptake of chloride. Therefore, experiments using striatal microsac preparations were carried out to investigate the possible modulation of chloride conductance by CHA and its relationship to ethanol. High concentrations of CHA (10 and 100 nM) increased the total chloride uptake by the striatal microsacs. Corresponding to the ethanol-adenosine interaction observed behaviorally, a much lower concentration (1 nM) of CHA, being ineffective itself, significantly enhanced the stimulatory action of ethanol on chloride uptake. This effect was blocked by either Ro15-4513 (100 nM) or DPCPX (10 nM). The modulatory effect of GABA and/or ethanol on chloride influx was also evaluated, and the results supported the appropriateness to use striatal microsac preparations in the present study. Overall, the data suggested a functional interaction between ethanol and striatal adenosine and further supported the hypothesis that striatal adenosine might, in part, modulate ethanol-induced MI through its effect on chloride conductance through chloride channels coupled to GABA-benzodiazepine receptor complex.

Ethanol-induced alterations in beta-endorphin levels in specific rat brain regions: modulation by adenosine agonist and antagonist

Previous studies in our laboratory have indicated that ethanol alters beta-endorphin (beta-EN) levels in specific rat brain regions. The present investigation was conducted to evaluate the effects of an adenosine agonist and an adenosine antagonist on these alterations. Male Sprague-Dawley rats weighing 150-200 g were used in this study. The animals were injected intraperitoneally at 11.00 h with ethanol (3 g/kg as a 22.5% w/v solution in saline), N6-cyclohexyladenosine (CHA; 0.1 mg/kg), theophylline (30 mg/kg), a combination of ethanol and CHA, or a combination of ethanol and theophylline. The control rats received saline. The animals were sacrificed 1 h after injection. Frontal cortex (CTX), hypothalamus (HY), hippocampus (HI), and midbrain (MB) were dissected, and their beta-EN levels were determined by radioimmunoassay. Ethanol administration significantly increased the beta-EN levels in HY (39% increase), HI (28% increase), and MB (19% increase), but had no effect in CTX. The adenosine agonist (CHA) produced similar significant increases in beta-EN levels in HY and MB, but did not alter these levels in CTX or HI. In contrast, the adenosine antagonist theophylline did not alter beta-EN levels in any brain region studied. However, theophylline pretreatment significantly reduced ethanol-induced changes in beta-EN levels in HY, completely blocked ethanol effects in HI, and reversed ethanol alterations in MB. On the other hand, CHA, concurrently administered with ethanol, potentiated ethanol-induced increases of beta-EN levels in HY and HI. These findings suggest that the ethanol-induced increases in beta-EN levels in specific rat brain regions may be modulated by adenosinergic compounds and that adenosine receptors may play a role in ethanol effects on rat brain levels of beta-EN.

Possible central adenosinergic modulation of ethanol-induced alterations in [14C]glucose utilization in mice

The possible role of brain adenosine in acute ethanol-induced alteration in glucose utilization in the whole brain, as well as in the specific brain areas (cerebellum and brain stem), was investigated. Mice were killed 20-min postethanol, and the fresh tissue slices (300 microns) of brain and/or specific brain areas were incubated for 100 min in a 5.5 mM glucose medium in Warburg flasks using [6-(14)C]glucose as a tracer. Trapped 14CO2 was counted to estimate glucose utilization. Ethanol (2 g/kg, i.p.) markedly increased the glucose utilization in whole brain and in both motor areas of brain. Theophylline (50 mg/kg, i.p.), an adenosine antagonist, significantly reduced ethanol-induced increase in glucose utilization in whole brain, as well as in brain areas. However, adenosine agonist N6-cyclohexyladenosine (CHA; 0.1 mg/kg, i.p.) on the contrary, significantly accentuated ethanol-induced increase in glucose utilization in these tissues that was nearly completely blocked by theophylline pretreatment. Theophylline alone did not produce any significant change in glucose utilization, whereas CHA alone (in vivo and in vitro) significantly increased glucose utilization, as well as ethanol-induced increase in glucose utilization in an additive manner. Relevant supportive data were obtained by experiments in which adenosine deaminase (ADA), p-sulfophenyltheophylline (8-SPT), and CHA were administered in vitro to the slice preparations. Both ADA and 8-SPT were effective in almost completely blocking the ethanol-induced increase in glucose utilization, whereas CHA further enhanced the ethanol-induced increase in glucose utilization in an additive manner.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo effects of (-)-nicotine on ethanol-induced increase in glucose utilization in the mouse cerebellum

The purpose of this study was to investigate the possible in vivo effects of (-)-nicotine, ethanol, and an adenosine agonist N6-cyclohexyladenosine (CHA) when injected individually as well as in various combinations on glucose utilization in the fresh cerebellar slices of mice. Mice received ICV (-)-nicotine or CHA followed 5 min later by a test dose of ethanol (2 g/kg; IP). Animals were killed 20 min postethanol treatment and fresh slices (300 microns) of cerebellum were incubated in a glucose medium in Warburg flasks using 14C-glucose as a tracer. Trapped 14CO2 was counted to estimate glucose utilization. Ethanol treatment markedly accentuated glucose utilization, whereas the pretreatment with (-)-nicotine (125 and 250 ng, ICV) resulted in a significant attenuation in the ethanol-induced increase in glucose utilization. However, ICV (-)-nicotine (125 ng) alone did not produce any change in the cerebellar glucose utilization. The attenuation of ethanol-induced increase in glucose utilization by (-)-nicotine was nearly totally blocked by ICV hexamethonium, a purported nicotinic antagonist, suggesting participation of cholinergic-nicotinic receptors. The (-)-nicotine pretreatment also significantly attenuated both the ICV CHA (25 ng)-induced increase in glucose utilization and the accentuation of ethanol-induced increase in glucose utilization by CHA. The antagonistic effect of (-)-nicotine on CHA- and ethanol-induced increase in glucose utilization indicating an interaction between (-)-nicotine and ethanol and between (-)-nicotine and adenosine may suggest involvement of postreceptor (nicotinic and adenosine) mechanisms including ionic channels.

Characteristics of cocaine interaction with delta-9-tetrahydrocannabinol on glucose metabolism in the rat testis

In this study, the characteristics of cocaine (COC) interaction with delta-9-tetrahydrocannabinol (THC) on glucose metabolism in the rat testis were investigated at different time points. Rats receiving 20 mg/kg IP COC at 0830 h and sacrificed at 15 min, 30 min and 60 min posttreatment showed no change in glucose metabolism. Moreover, 5 mg/kg, IV, COC treatment at 0900 h to rats and sacrificed 60 min postexposure, also produced no change in glucose metabolism. However, at 1300 h, the same protocol with IV COC treatment resulted in a significant increase in glucose utilization by the testis. Furthermore, a THC dose of 10 mg/kg, PO to the rats at 0830 or at 1130 h, followed by sacrifice 90 min later caused a significant decrease in glucose utilization at both time points. Similarly, when rats were given both THC and COC (THC at 0830 h, COC 90 min later) and sacrificed 60 min post-COC, it resulted in a further decrease in testicular glucose metabolism as compared to the rats treated by THC alone. On the other hand, concurrent exposure of rats to these drugs at 1300 h with same protocol, ended up with no change in glucose utilization in the testis. These data suggest that not only the route of administration but also the time of exposure plays an important role in defining the nature of the effects of COC/THC interaction on rat testicular glucose metabolism.

Teratogenic effects of benzo[a]pyrene in developing chick embryo

The effect of benzo[a]pyrene (BP), an established carcinogen, on developing chick embryos was investigated. The embryos were exposed in different stages of development to various doses of BP via the yolk sac route. This resulted in retarded growth, as reflected by lower embryonic body weight, reduced crown-rump length and bill length. Abnormal survivors showed remarkably twisted legs with shortening of the bones, abdominal oedema, haematomas, blisters and a short neck. These findings suggest that BP is a teratogen when injected via this route, and the 'oedema syndrome' is a possible mechanism causing teratogenic effects in developing chick embryos when treated with BP.

Antagonistic effect of zinc in lead treated developing chick embryos

Lead (50 micrograms) and zinc (100 & 200 micrograms) alone and in combination, were injected on 7th day of incubation into the yolk sac of developing chick embryos. The deformities induced by Pb alone included reduced hatchability, growth retardation, hydrocephalus, defective beak and legs, microphthalmia, anophthalmia and curling of hair. The concurrent exposure with Zn (200 micrograms), however, provided a remarkable protection against lead induced deformities, reflected in terms of almost normal development of chick embryos with increased hatchability and lower incidences of malformations, and mortality.

Protective role of calcium in lead toxicity during development of chick embryo

In the present study the interaction of lead (Pb) and calcium (Ca) during embryogenesis was investigated. Lead (50 micrograms) alone and in combination with Ca (100 micrograms, 500 micrograms and 1000 micrograms) was injected on seventh day of incubation into the yolk sac of developing chick embryos. Treatment with lead alone caused stunted growth in chick embryos with several deformities e.g. defective beak and legs, hydrocephalus, microphthalmia and anophthalmia. The combined treatment of Pb with Ca showed a remarkable protective effect against lead induced deformities characterized by development of chick embryos with a low incidence of deformities.

Effect of simultaneous exposure to nickel chloride and benzo(a)pyrene on developing chick embryos

In the present investigation the effect of Benzo(a)pyrene (BP) and Nickel chloride, quite often identified in crude and refined or waste oil, when injected in combination, was investigated on developing chick embryos after exposing them through yolk sac route on 6th day of incubation. Exposure to this combination in different doses resulted in no new deformities other than those experienced in BP treated chick embryos. The mortality and malformations experienced in the chick embryos exposed to BP alone and NiCl2 alone were seen to be added when both the chemicals were simultaneously inoculated into the same chick eggs.